Friday, August 12, 2011

What is a PhilHealth MDR (Member Data Record)?

Whenever you need to avail of your PhilHealth benefits, you will always be asked to provide the health care institution (hospital) a copy of your MDR to be attached to the claim forms. For those who are new to the term, an MDR, short for the Member Data Record is a system-generated document being issued by PhilHealth as a primary attachment to the Claim Form 1.

What does the MDR contain?

The document contains the member's basic information such as the PhilHealth Identification Number, full name, address (local and/or foreign), civil status, date of birth, contact information and for those employed or under the KaSAPI Program the PhilHealth number, name and address of the employer or organized group is reflected.

Aside from the basic information of the member, a list of valid dependents (with their complete name, birth date and other info) who may avail PhilHealth benefits are also displayed along with payment information for OFW members and the validity or effectivity date for sponsored members.

Reduce incidents of returned claims due to lacking supporting documents;

Lessen claims that are doubtful in nature.

In addition to this, prior the implementation of the MDR requirement, members are required to submit supporting documents (e.g. birth certificate of dependent who was confined, marriage contract etc.) to be attached to their claim form in order to avail PhilHealth benefits. Supporting documents are necessary for PhilHealth to establish the relationship of the member and the patient or the person that was confined to prevent unauthorized usage of the member's annual 45-days allowable period. Hence, there is no need for a member with an updated MDR to attach several supporting documents to avail PhilHealth benefits as hospitals may refer to the MDR to establish the relationship of the patient to the member.

What to do if you are not able to get the document?

Although the MDR is a primary document, PhilHealth does not say that a member cannot avail benefits if this document was not provided. For those members that are unable to provide the MDR, the corresponding supporting documents must be attached to the claim forms in order to avail the benefits.

Where do you get this document?

Any PhilHealth Office (with system access) can provide or issue the MDR.

73 comments:

Speaking as an ordinary PhilHealth member and not as someone who is familiar with the processes and procedures for submitting a claim, I can't really see the point of requiring the attachment of the MDR when it is PhilHealth who is also issuing it.

Seems redundant, and it is only indicative of PhilHealth's internal inefficiency as it would seem, that the claim processors do not have access to the MDR, so they have to require the member to attach it.

I can understand the need to attach birth certificates, marriage contracts, etc., if the dependent being claimed for is not in the MDR. But to require the MDR as an attachment when the MDR itself came from PhilHealth? Another requirement which can probably be dispensed with if PhilHealth were a wee bit more efficient.

Point well taken. However, members should also note that health care providers (hospitals) are not connected to PhilHealth. They have no idea who are entitled to avail of PhilHealth benefits particularly the dependents since that information may only be available in the MDR or established by providing supporting documents.

Hence to do away with requiring the member to provide the supporting documents every confinement, they would need to have a copy of the MDR which can be claimed/requested free of charge, compared to the supporting documents such as birth certificates where they have to pay for a copy.

To simplify the process, the members should not lose the MDR that was issued to them so that they would no longer need to go to PhilHealth for re-issuance unless changes are made to their record. I believe they can just photocopy the MDR and retain the original copy for future reference.

We do hope that PhilHealth would be able to establish connection with hospitals or provide an online facility in which members can print their MDR to make things easier for the member and for them as well.

for me Philhealth should ease the process for the members, and i think the member should only show their philhealth card or number and everything will be taken cared of like other health inssurance, inst it philhealth is a health inssurance? why they kept this very scrutinizing process which sometimes members get annoyed of it and waived the claims because of troublesome process and requirements, if it is truely for the benefits of the filipinos why they have this difficult process else make it more easy to members or abolish it and stop requiring every working filipinos to contribute to it even they dont need it specialy if they have a covered medical insurance which can be used more easily or contributing to philhealth that u cant even use even in times of needs. for ofw everytime you get the OEC you are oblidge to pay for philhealth and even u put updates to the form e.i. adding benneficiaries for new member of the family, they are not updating your mdr then when time comes you need the said benefits it is very hard for you to claim it. and the ofw is not there anymore to update the details or takecare of the inefficiencya nd neglegience of philhealth office adn staff.. if it is truely for the people they should make it easy by just showing hospitals and doctors the philhealth members id and number and its hospitals and philhealths part to print the MDR, etc.. members should be treated as nice as they are the contributor and they put money on it forcibly, else if better make it voluntary to those who are willing only, i bet few will because of the service of the said office. officials should use there head and think this way. not just sit there and take a big buck salary from our pocket, remember its peoples money that pays all of you, imagine an ordinary worker is paying you you should go to work and not just sit there. think of better ways to provide the members a better way to avail the benefits or it is intended to make it difficult so few can avail the benefits.

PhilHealth cards does not reflect your qualified dependents thus, it will be difficult on the part of the hospital to determine if the patient can indeed claim PhilHealth benefits without supporting documents establishing the relationship of the patient to the principal member. The list of dependents qualified to avail PhilHealth benefits is reflected in the MDR of the principal member.

I see the point which would make it more difficult for health establishments to identify if the dependent is indeed qualified however for first timers who wants to avail this, they will indeed be burdened in cases when the phil health offices are closed(weekends and holidays) and there's a need to get MDR for them to check out which they would have to wait for another working day not to mention they would have to extend their stay in the hospital which affects the bills. Just saying.

everything is automated except for philhealth?!knowing that you have numerous members... if only we could have enough resources to pay for our hospital bills we will not be asking for your assistance then.... x_x

I agree with Placebo and Anonymous (Nov 9, 2011 11:51 PM). Make a way to continously improve the process. Having to get and fill in so much forms to avail the benefits is so backward thinking. Stop complicating things that can be done simply. If Philhealth card don't reflect everything that you need, then make a way to make the card more useful than just a mere ID. We're already in the cyber era; there should be less physical papers to process anymore.

I am an OFW. When i went home last November 2010 for my annual vacation, I personally processed my OEC and I paid the annual premium of Philhealth in POEA office in the same month/year. So it is understood that my coverage would be up to November 2011. But due to global recession, my employer in UAE instructed me to extend my vacation in the Philippines because we have no available project at that time. Unfortunately, my employer terminated my employment during my extended vacation thus i was obliged to work locally and I was employed by a company in the Philippines last April 2011. I informed that local company that I already paid my premium up to November 2011 but nonetheless, they keep on deducting monthly premiums from my salary until I resigned last August 2011 because I got a job offer here in Saudi Arabia. So again I paid for the annual premium before leaving the country last August 2011 which I understand will cover me up to August 2012. Now HERE IS THE PROBLEM.. My son is in the hospital now. So my wife went to the nearest Philhealth office in our place to get my updated MDR and she brought with her the copy of my OEC which clearly indicates that I paid last AUGUST 2011. But to my wife's surprise and to my disgust, MY MDR ONLY REFLECTED MY PAYMENT UP TO NOVEMBER 2011. Ang sabi doon sa Philhealth office (San Carlos City Pangasinan)Di pa daw nagreremit ang OWWA? OWWA????? HeLLO!!! What does OWWA have to do with PHILHEALTH CONTRIBUTIONS?? Ang alam ko po, PHILHEALTH mismo ang komokolekta dun sa POEA office at di kung sino pa mang opisina. This employee of Philhealth has an apparent lack of knowledge for his/her job and doesn't deserve to be there. But the question is... SAAN PO NAPUNTA ANG IBINAYAD KO? SAAN NAPAUNTA YUNG MILYON MILYON NA IBINAYAD NG MGA OFW? According to Statistics, 3000 Pinoys leave the Philippines as OFW daily. And assuming na di nagremit yung POEA office nila (I Find this very very weird) mula nung umalis ako 8 months (240 days) ago times the amount of 900 pesos times 3000 OFW's leaving daily EQUALS A WHOOPING 648 MILLION PESOS.SINO PO NAGTATAGO NG PERA NA TO? SINO NAKAKAALAM? ALAM PO BA NI PRESIDENT NOYNOY 'TO? May magsa SUFFER at may MAGPAPAKASASA? Anlaki na ng bill namin sa ospital now at di namin alam kng sino malalapitan sa problemang to. PILIPINAS... GANITO KA NA LANG BA FOREVER??? AKALA KO BA MATUWID NA ANG DAAN? GUSTO KO NA MANIWALA NA YUNG MATUWID NA DAAN AY DI PANG KARITON OR JEEPNEY OR TRICYCLE.. KUNDI PANG PORSCHE LAMANG!

As far as we know the philhealth payment are integrated in the owwa payment, hence the money would end up with owwa first and then remitted to philhealth. However, i think that philhealth will be able to update your mdr upon request and copy of the poea receipt and issue a new mdr. You can try to email philhealth directly at info@philhealth.gov.ph to inquire if you can just attach a copy of your receipt and mdr to avail philhealth benefits.

As long as the confinement date falls within the validity of her husband's PhilHealth eligibility, then she would be able to avail benefits provided other conditions on availment is complied with such as confinement shld be in an accredited hospital etc.

What are the supporting documents needed, if MDR is not updated(employer), i had a copy of my previous MDR, i already accomplised cert of contribution (current emplyer) together with the receipt of premuims paid. but the hospital required me to submit a copy of updated MDR, it is imposible to me to leave my daughter alone in the hospital.

If your employer reflected in the mdr is not updated, you might be able to coordinate with your employer to submit an ER2 for PhilHealth to update your profile. The ER2 serves as a certification that you are indeed employed there. You can ask a representative to hand over the ER2 and immediately get a copy of your mdr with your authorization letter and valid ID. The hospital might be just confirming as the claim form 1 will be signed by your current employer which is different from that declared in your mdr.

I'm a seafarer. I've been a member of Philhealth since my first contract last 2007. My company (Maerskline) is the one deducting my salary for the monthly premiums or, I'm not sure if it's deducted monthly or for the whole year from my contract's duration (6 months every contract). In 2010, I got married but was not able to update my MDR up to now. My wife is pregnant with our first child at present and since she's not working anymore, she has not continued paying for her personal membership and so we will use my own. My contract will end last week of August 2012 and my wife is due to deliver around October or November. Is it still covered even if I am planning on staying home for vacation until December 2012? Where do I go to update my MDR? I also wish to iclude my 8 year-old step-daughter as dependent (her child from her 1st marriage which has been legally annulled)? What pertinent papers do I need to submit? Please help. Thanks.

Good day! Please be informed that this email account "info@philhealth.gov.ph" has been deactivated. All inquiries, queries, requests, complaints and other concerns shall now be coursed through actioncenter@philhealth.gov.ph

Yes, ngayong january ay nagtaas na ang premium rate ng PhilHealth. We will try to postthe new bracket. Ang dati kasi expected na increase this year ay 200 per month, pero mukhang ibinaba muna sya. We will try to get the details and post as soon as possible

PhilHealth 101

All the practical information you wanted to know about the National Health Insurance Program and PhilHealth you can't get from anywhere else.

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